By a Thread
by HappierThanMost
Summary: Days are never predictable in the ER for Dr. Curtis.


**_Warning: Surgical details might be a little too graphic for some._**

 _I had this urge to write about a day in the life of Dr. Curtis, so this goes along with Fixed and occurs at the same time. I hope someone else out there might have an interest. Please forgive any medical mistakes. I did some research to make it more real, but tried not to make it too clinical, hoping to add the humanity aspects of being a doctor. Because, come on, it's Ponyboy Curtis!_

 **BY A THREAD**

Hippocrates once said, "Wherever the art of medicine is loved, there is also a love of humanity." I try hard and remember those great words of our Father of Medicine, but humanity always seems to get lost somewhere in my cozy tangled blankets once the one a.m. alarm so cruelly yanks them away.

A quick shower and shave can't even slap me awake, especially since every move is methodical and noiseless, meant to spare my sleeping wife. The light's contained to the hallway, and its narrow golden beam shining through the cracked door of our bedroom is my guide to the chair. It's there my clothes wait for me, the ones I lay out religiously the night before, so that little thought's required to throw something on. Otherwise, there's no telling what I'd be wearing rolling into work, if anything at all.

I manage to run a comb through my hair, tie laces, fasten a watch all without sight, so I'm tuned in to other senses, and I focus on the sound of a tree branch clawing at our window and Caroline's light snores, a new development in this late stage of her pregnancy. I'm ready in a matter of minutes and close the door on the only place I want to be right now.

On my way through the kitchen I notice a note left out, held firm to the table by the granola bar on top. It's our usual method of communicating when I'm working strange hours, our only bridge sometimes between the upside down worlds we float through. Her little note's a flash of daytime, a comet streaking through my nocturnal existence. I mindlessly tear open my breakfast and read the perfectly straight-lined writing of a first grade teacher.

 _Darry called after you went to bed. He wants his staple gun back Loser-his words, not mine. Plus you owe him twenty for that Steelers bet. Damn you look hot when you're asleep-my words, not Darry's._

I smile then wince at how this granola could shatter teeth and I wonder why she didn't buy the chewy kind.

Digging for the key to lock up the front door, the wind whips wildly against an angry shutter, the one Darry and I tried to fix but only managed to rig up temporarily, too loose for Darry's liking, too trivial for me to care. I pause on the front walk and welcome the gusts that manage to spark some life in me, and send the clouds off on their highest speeds, making the full moon appear as a sailing ship racing on the night's strong deep-sea current.

My car's where it happens. Where I'm restored to a semblance of human once again. As I drive the empty streets, the radio reminds me I'm not some lone apocalypse survivor. There'll always be the three of us in these darkest intimate hours: music, the ever too mellow DJ and me, and I warm up a raspy voice by singing out to the songs chosen by Coyote Calhoun and his Easy Listenin' Midnight Tunes. I could use some harder, pulse pounding rock right now but I'll take what I can get.

I pull into the twenty-four hour truck stop on the highway and get my styrofoam cup of coffee, made in only the way truckers and other night crawlers like me can appreciate. With the swift kick of liquid restoration.

I take off with my steamy cup and a pack of Nicorette gum to get me through my day of no smokes. I wonder how I'll form a new life where I'll never crave a cigarette, and I've been working to reach that impossible goal as I race to quit before the baby arrives. The thought of dealing with things like my job without the crutch of smoking makes me tense, but I turn up Toto's Africa and _there's nothing that a hundred men or more could ever do_ renews my motivation. I'm still singing out when I pull into the doctor's lot of Hillcrest Hospital, and I hear the rustle of at least twenty empty styrofoam cups of my past rolling chaotic over the floorboard when I brake. I can't be bothered to clean it out so I'm relegated to drive this 'trash can on wheels', Caroline likes to call it.

I walk across the parking lot and calculate when I'll have the day shifts this month. It's always hard to switch internal clocks, but it's so nice to have a sense of normalcy, to live in the waking hours of the world's majority. And I watch the Emergency doors already bustling as I make my way to the back entrance, and I wonder what awaits me. Nothing's predictable in a day's work; I'll never know what's about to come walking through my lobby, and that's exactly why I choose it.

I sneak in, slumped shoulders trying to be invisible, not wanting my arrival noticed since my shift hasn't officially started. Clinging to peace for as long as possible, I try to avoid the questions, the complaints, the demands of a staff already hyped up on work's adrenaline, and I'm off for the locker room with head down to change into my scrubs. My first pair of the day, fresh before the onslaught of blood and bodily fluids splatter them unwearable.

Once dressed, I'm finally ready for interaction and go to the breakroom for the sports page and a shot of the coldest orange juice in town. I peel off the aluminum foil of the tiny plastic cup and throw it back, an almost frozen sludge of pure goodness sliding down my throat and I join in the already underway bawdy conversation of Brown from ICU and Taylor from Orthopedics. People might be surprised the Doctors' Lounge is rarely a solemn or mature place, instead full of laughter and crude jokes, light topics necessary to escape the stress of being in full blown medic mode outside our private doors.

I envy the OR doctors who have the luxury of their patients being fast asleep. In routine procedures, they get to cut with the stereo blasting through their sterile icehouse rooms, freezing temps to fight the heat of their mega watt spotlights, and many surgeons have their preferences on the music that they work best under. I could get used to that, but I'm only allowed whatever melody's stuck on repeat inside my head. And the whistling of Lou the janitor.

"Curtis, you wanna get in on this real estate deal with us down in Boca? It's a buyers' market man." Taylor's eyes sparkle with a rich man's delight, and I shake my head and smirk.

"Lemme check with my financial advisor, oh wait, I mean my debt collector," I say dryly while they both laugh and I fold up the paper to leave for someone else. "Taylor, I'm still in the poorhouse," I add with a shit eating grin, " _and_ I'm still young and good lookin'. You like to forget you're ten years older than me."

"It's called a loan dipshit, look into it," Taylor says in the spirit of good natured ball busting and tells me I'm an idiot for passing on this one. I have to leave for my post, but on my way out I shake Taylor's hand, the hand of an orthopedic surgeon, made strong from years of hammering and sawing through dense bone.

Down the corridor I can already hear it. Ron Kelsey's coming off shift and letting loose on the nursing staff. He's one of many known for being a real dick to nurses, throwing equipment when something's not already laid out for his use, berating them for not having stats ready to roll off their tongues when they come to him for orders, angry over their questions he deems trivial. Right now he's attacking Lisa for handing him the wrong chart, a mistake I'm sure she immediately recognized and corrected. Lisa's one of our best.

I sure don't claim to be God's gift to nurses, but I'm a hell of a lot better than Ron. I try to be fair and patient cause they're my eyes and ears on the floor, and I'd rather they ask me again what I just ordered rather than guess at it, all because they were afraid. I don't bite. Not usually. Plus, the easy smoothness of a shift depends on the smoothness of its team. And it's their job to come get me when things take a turn for the worse on any patient, and if you as an ER doc can't handle five or more interruptions while you're in the middle of giving a treatment, you weren't meant for this job. It's a matter of deciding who's most at risk of death at the moment, and that's who you go to first. I expect my nurses to come give me the lowdown so I can make those decisions.

Lisa's aiming for the linen closet when she spies me, rolling her eyes. "Thank God you're coming on the floor Dr. Curtis. I've been on six straight with Raging Ron over there."

As she's throwing towels over her arm, I pop in a piece of gum and tell her, "C'mon Lisa. Ron sounds chipper today. At least he's not calling Juanita an ignorant fuck again."

Lisa breathes out a chuckle and walks back with me towards the desk where we always meet for shift transition, "Well with you we only have to put up with a couple of your quirks," she says with teasing in her voice.

"Oh yeah, what's that?" I ask, noticing the halls aren't stuffed with triage so maybe this morning we won't be so busy.

"Constant gum chewing and your God awful taste in music. If you're not smacking those jaws you're humming some kind of hard rock garbage."

"Well, Lisa, you're about to get a reprieve," I tell her breaking into a wide smirk and tapping my temple. "I've got Toto stuck up there today."

"Oh Jesus help us all," she says eyeing the ceiling as we join with the staff surrounding the nurses' station of charts and bulging files, ready to hand off the batons between shifts, some clocking in and others clocking out, but a handful who remain in the middle of their own shifts, so there's always a group to maintain a consistent flow.

I actually put great stock in the moon, and when it's full like tonight, so is our Emergency Department, many times turning into a ward when the hospital is slow on admittance and short on beds. So I'm pleasantly surprised we're not busting at the seams. Head nurses update us on current patients, their stats and what they presented on arrival. A couple of acute stomach pains, a laceration, chest pain, a pediatric patient with fever induced seizure, a possible femoral fracture, a team working now on an arrival that EMS already intubated.

"Yes," I whisper and pump my fist once like I've hit a jackpot, "now that's what I call delivery. Already givin 'em to me tubed up and ready to go."

"You're welcome," deadpans Ted who happens to be in the vicinity.

After rundowns of vitals and labs still out, Ron fills me in on a call he has with Neurology over possible stroke in four, now stable, and tells me that Cardiology's been pussyfooting around again all night. He's already yanking off his stethoscope, about to be off the clock for a two day break. I slap his back and tell him to enjoy it. He's really not a bad guy. Burn-out is real in this business.

I step out in the bright fluorescent lighting, hit with the constant smell of vomit and blood that no cleaner can mask, and start in on my twelve hour shift like any other. My hands are always full juggling a thousand fires, but it's much less drama than people think. I'm usually waist deep in UTIs, broken bones, intubations, draining abscesses, stitching, pelvics, and talking down the addicts who keep coming in for "back pain".

 _"Hey Ponyboy, man um this back keeps flaring up. Would you mind calling me in some pain meds?"_

 _"How 'bout you come in for an x-ray tomorrow instead and let's take a look at it Soda."_

I try and put that last phone conversation with my brother out of my mind for now.

But I'm also trained for the critical moments, when the real emergencies come in. I'm the front line in diagnoses, making split second decisions with little or no information on the patient to go off of, and gut reactions are my expertise.

Three hours in and so far it's been pretty run of the mill...

 _"Does this hurt?" I ask and press against his abdomen. He winces in pain. I turn to Lisa. "Order an abdominal."  
_

 _xXx_

 _"Would you please look over towards the door for me," I instruct shining my light into the milky eyes of cataracts. "Okay, now look at me please Mrs. Willis..good, that's good."_

 _xXx_

 _"Mrs. Grayson you're back to see us!" I say with feigned delight. " How long's it been? Yesterday?"_

 _xXx_

 _"Alright Jennifer, when was your last cycle? Would you say the pain's sharp or dull? Okay, let's get your feet in the stirrups and scoot down the table for me," and I pull up my stool between her sock feet. "I'm just gonna take a quick look and see what we got going on down here. Okay you're gonna have to scoot further down..towards me.. a little further, nope further than that... further."_

 _xXx_

I've sent a six year old to OR with an appendicitis, I've called the psych ward on Mrs. Grayson yet again, and the big guy who presented with chest pains coded on Lisa when she was taking his vitals ...

 _I take over chest compressions for her while she readies my airway equipment, my hands pumping to the beat of the song that's been running through my head all morning. I silently sing to myself,_ Gonna take a lot to drag me away from you _and use the measured beats to time my thrusts, a habit I've developed over the years. Using a song to keep time...and keep my head through all the tension._ I bless the rains down in Africa _,_ Gonna take some time to do the things we never have _. What the hell does this song even mean? Pull through damnit. C'mon man, thirty-seven's too young. I think of Darry._

 _After we stabilize him with a definitive airway and send him off to Cardiology who finally opens up for us, I'm riding off the high of saving._

 _Lisa breathes relief and throws her hand on my shoulder. "Well, what song was it today? Don't tell me Africa."_

 _I pop in another piece of gum and smile, "The miracle of Toto pulled us through Lisa."_

Only an hour left already and I've got my mind on Caroline, ready to go home and eat a tub of ice cream with her on the couch. "Dr. Curtis, there's a patient in room two. Pregnant, thirty-three weeks. She's presenting some pain with nausea, sporadic contractions, a little bleeding. Heart rate elevated."

I wash up and head in, look at the chart and smile at the expectant mother. She manages a smile back though I know she's worried over her condition and I feel for her. I know Caroline would be a wreck right now. I try and put her out of my mind and be as comforting as I can.

"Where does it hurt," I look at my chart, "Josephine? Are you feeling a lot of pressure on your cervix?"

"I'm hurting all over really, even up to my chest, and you can call me Jo." Her voice is sweet and her eyes are warm even if they're lost in quiet panic. I glance again at her chart and notice she's over thirty-five, AMA.

"Well let me take a look and let's figure this out okay? Angela, can you help her up on the table?"

Angela, our friendliest nurse creates the pleasant small talk while she gives Jo support, getting her on the table and helping her lie back while I pull out my doppler.

"Dr. Curtis," Angela's voice is alarmed and I turn back around to see Jo's eyes rolled back. "No pulse," Angela calls out and my stomach drops. The world shifts to slow motion, and I raise from my stool and my foot sends it crashing behind me across the room. I call for backup and a crew works to stabilize this now flatlining woman. Is it a pulmonary embolism? There's no time to guess, cause I'm now face to face with what's considered the "Holy Grail" in all of emergency medicine. What no doctor ever wants to come across and only a handful ever do. I have a matter of minutes to cut this woman open and try and rescue a baby from its dying mother. A perimortem C-section.

Machines fire up, buzzers sound, the room starts filling with people while the air gets sucked out. "Call in NICU," I demand in a voice that isn't my own. "Cut her clothes." I feel slow while everything moves around me in warped and blurry speed.

Two pairs of scissors appear out of nowhere, already at work slicing through the bright yellow dress with expertise, panties are cut at at each side and fall away as a silver tray of instruments glides up before me and gloves are magically put in place.

All the activity swirling around the mother, the loud resuscitation attempts remain apart and separate from me now, a whole other world as I focus in on the bright light now burning down on this mother's swollen belly. The brown of iodine smeared all over haphazardly. Some nurse is tying the mask, the cloth across my nose and mouth and I ready my scalpel, remind myself I was first in my class in OBGYN and make a midline incision down the abdomen, slicing through all of its walls and with retractors I firmly pull and keep them open. I dissect down until I reach the uterus, making sure to avoid the bladder, then I make a vertical incision. Once I get an opening, I put two fingers in and lift the wall up and away so I can finish my cutting without risk of lacerating the baby, my bandage scissors furiously flying with agility and a grace that's not from me, and in a matter of seconds I'm pulling...him out. Staff starts suctioning immediately while I clamp the cord and I hate that he's not crying. He's way too quiet. They whisk him away to NICU while I deliver the placenta and look up for vitals on Josephine, to determine how I need to close her.

But I already know.

"I'm calling it," Briggs says in a big voice among the now quieting team. "Time?"

"1:47pm." Angela says trying to be matter of fact, but clearly with disappointment.

There's no need now to meticulously sew up the many layers for a woman who won't get up and live again. There's no need to take the steps of protocol after a "dirty" surgery like this. She has no risk of infections anymore. I work quickly to piece Josephine back together so the morgue can take her apart. But I still do it with respect and care. And my fingers never shake even when the adrenaline falls away.

I'm lucky Briggs is clocked in and doing the hard part. Telling the husband who's torn between grief down here and hope up in the NICU. I don't even look towards the lobby at the fallout, and I walk a slow and straight line to the nurses' station to numbly tell them I'm off the clock after overtime and I missed the shift change.

I leave my post a different man than when I came.

I'm a doctor. I'm rational. There was nothing I could do. And yet my brain can't stop wrestling with "where did I go wrong?"

Word's already out on what happened. Taylor squeezes my shoulder with his strong surgeon's grip when he runs into me in the locker room. I notice his scrubs are as bloody as mine. "Sorry Curtis, that's a tough case. Sucks man."

The sun is a shocking reminder that it's day and normal life's going on around me. I sit in my car for awhile, watch the people walking in and out of the building, and I can't stop thinking about that husband. How I would feel if I were in his shoes. What would I do if something happened to Caroline? I think I'd stop living.

I didn't ask after the baby and I'll never follow up. I don't want to know, preferring to believe that little boy I scooped out of his poor momma will grow up healthy and live a full life. Why shatter the only thing I've got? Hope. But I saw him. And it didn't look good.

I never follow up with the patients I diagnose and send on through hospital admissions. Once they leave my doors they're no longer mine, and once I've done all I can do, I drop them in the category of saved and move on. It's a belief system based entirely on self-preservation.

I start up the car and the styrofoam cups rumble to life. The radio's off on this ride home today and I finally start a regular pattern of breathing by the time I get to the east side. I crank down the window, spit out my gum and light up a cigarette. Today's not a good day to quit.

It's not my first loss and it certainly won't be my last. This one just hit home's all. And it's taking me a little longer to come off it. By the time I pull up my street, the nicotine's almost done its job, but I sure can't shake this heavy pull in my gut.

I'm not surprised to see Darry's truck pulled up in front of my house, half on the curb, half off. I pull into the driveway and cringe when I see him come out the front door, a little girl in tow. I'm not ready to be Uncle Pony just yet. I watch him guide her, a tiny hand in his big one and he takes the steps slowly while Molly hops down everyone, her fuzzy coat buttoned up to her chin while her tutu flies in a wind that hasn't let up since last night.

I watch Darry walk our worn and weathered childhood path to the front gate, and I think back on the man his age who went into cardiac arrest earlier. I notice how fit Darry still is and feel comforted that maybe his body won't give out for a long long time. He's smiling big holding up the staple gun while Molly dances around him all the way to my car.

I don't get out, but I do open the passenger window for them. "Well good golly, it's Miss Molly," I force out my usual greeting to my niece who isn't paying a lick of attention.

Darry leans down and asks in his usual blunt way,"Why the hell you sittin' in your car goofball?" Molly starts laughing a gap tooth grin, and Darry suddenly remembers he's with a daughter, "I didn't mean that Molly. We don't call people names. Daddy wasn't very nice was he?" He turns back to me and the little monkey in all pink is climbing him like a jungle gym, holding his hands to turn flips all while Darry's able to maintain a conversation.

He eyes me close, "What's wrong Pony? You look like you seen a ghost." I let a sad laugh escape when I think he sounds just like Dad.

"Nah, just a busy day's all." And I drag both hands down my face.

"Molly," Darry says while patting her tangled hair, "go wait for me in the truck alright?"

"But I'm hungry Daddy," she starts whining, only now just discovering she'll surely starve.

"Oh stop, you just had a fruit roll up ten minutes ago. Go on. I got some ketchup packets in the truck if you're that desperate."

"Yuck," Molly screams out at the same time I say "God Darry that's disturbing." But I can see Molly's wheels turning and I'm pretty sure she's up for anything, even sucking ketchup out of a little plastic packet.

"See ya Mol," I call out as she runs away and I'm lucky I get a blown kiss before she climbs up into Darry's shiny new truck.

I'm trapped now as Darry leans in the window on his arms. "What happened?" he asks and I know it's best to just tell him. I know he's probably worried it's something about Soda.

"I lost a patient today. It happens. I'll be fine."

"You don't look fine. I've seen you lose one before and you didn't sit in your car like someone afraid to step out into life again." Darry remembers everything.

"It was a pregnant woman. She just up and died on me and I had to get the baby out." I say this like I'm telling my brother I had a bad day at the office cause the copy machine broke down.

"Ahh I see," he stands up now like he's got all the answers. And maybe he does. "This weighs real heavy then. Pony, that's terrible. Man, I can't imagine." We both say nothing for a moment and shake our heads against the thought of it. I wish he'd tell me to get over it but he doesn't.

"Just reminds me how life hangs by a thread," I sigh, mad at myself for letting these thoughts back in, the ones I thought I had a handle on. I can't afford this kind of sensitivity in my career. I need to thicken this skin before I choke on all the whys of the universe.

"You bet life hangs by a thread," and Darry's not trying to make me feel better. I look at him with surprised eyes. "You've known that since you were thirteen years old Ponyboy. It was always hanging by a thread; before you were ever born it was, and it was yesterday, it was danglin' on a thread today and it'll cling to one tomorrow."

He smiles when I say, "Thanks for the pep talk, Dar," with dripping sarcasm.

He goes on in his most fatherly tone, the one he developed long before we'd ever dreamed he'd have to. "Not even a doctor can save someone when God decides your number's up." Then for some reason he's actually laughing a little. "And Ponyboy," his smile is causing his eyes to crinkle. "you ain't God."

I wrap my hands around the wheel and study them. Let the words sink in.

"Good news is," he raps the door with his knuckles twice, "right here in this moment, you've got a sweet and very pregnant girl waitin' in there for you, a baby on the way that's gonna turn you upside down and inside out in love. All we can see is the here and now, and that's all we're meant to know, all we need to know."

Suddenly the horn of Darry's truck erupts, blaring throughout the neighborhood making both of us jump. I grasp my heart with my hand and Darry turns around to the truck screaming, "Dammit Gigi, you best lay off that horn right now girl."

"What? Gigi's been in the truck this whole time?" I ask and look through the rear view to see my oldest niece in the driver's seat, sock foot propped up on the steering wheel, and I'm guessing her other one grinding on the horn. There's no two ways about it. The girl was born nuts.

Darry's pointing at her now, giving the glare but it's not helping. I feel laughter bubbling in my chest watching it go down.

Darry rolls his eyes and turns back to me. "I gotta go. Pony, pray to God you have a boy. Hey, you want me to come back with this staple gun and help you put up your Christmas lights on the house? "

I refuse his help but he'll never listen. "C'mon Scrooge, it won't take long. I know that roof like the back of my hand." And just like that I feel normal again. Darry's given me a path back with his Christmas lights. Life really does go on.

"Okay," I give in, cause it's easier to, and he nods and I watch him climb in the cab with two of his girls, fire it up and head home to his others. I catch a glimpse of a ketchup smeared face as they pass by.

I take a deep breath, step out of the car into the glow of a fiery sunset. The wind is still a wild and welcome friend and as I stand here taking all of it in, I realize I was never made for thick skin. I was born to be sensitive. And it's a big reason why I'm such a good doctor. I wouldn't want situations this terrible to escape my feelings. This should never feel easy. A life was lost. A mother, a wife. Where would the love of humanity fit in a cold, uncaring doctor?

I've always known how fragile we are, how precious. Darry's right, nothing's changed and neither have I. We all get reminded of this every now and then and today, the cold tap of mortality on my shoulder made sure I remembered. That's all. I go back into Caroline.

"Hey babe, how was your day," she asks draped across the couch, beautiful. Salvation.

"Fine," I tell her as I take off my coat. "It was fine." I get on my knees beside the couch and hug her waist, put my head against her stomach, feel our baby moving around and thank God for this moment. Cause the moment's all we can be sure of. And it has to be enough.

 **A/N:** Outsiders by SE Hinton, and the song running through Pony's car and then through his head all day- Africa by Toto

 _I really appreciate all those readers who give their time-Time is precious. So thank you!_


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